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Almulhim, F , Thwaites, PA orcid. Springer, Cham , pp. The proper tongue muscles are m. Tongue is supplied through a. The innervation of the tongue is performed by n. Lymph backflow: submandibular lymph nodes collect lymph from frontal parts of the tongue, retropharyngeal lymph nodes collect lymph from posterior parts. Part 1: The Head 67 Sublingual salivary glands. A single gland weights about 5 g.

Glands have flattened oval shape. The main excre- tory duct opens into the sublingual caruncle. Small ducts open into the sublingual fold. Blood supply is carried out through branches of the lingual artery. The fundus of the oral cavity. It is formed by the complex of soft tissues which are located between the tongue and the skin of suprahyoid part of anterior neck region. Mouth fun- dus is composed of oral diaphragm, diaphragma oris, formed by the geniohyoid muscle, m. Above the dia- phragm in the sagittal direction there is m.

Between the radix and the corpus of the tongue there is a blind foramen, foramen caecum.

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During the embryonic period it opens into the ductus thyreoglossus. Buccal region Fig. External marks of the buccal region are the zygomatic bone and zygomatic arch, the bottom edge of the lower jaw, nasolabial fissure, and the anterior edge of m. The limits of the buccal region: the upper limit of the buccal region is zygomatic arch, the lower limit is the lower edge of the lower jaw, the anterior limit is the vertical line drawn from the outer corner of the eye, and the posterior limit is the palpable anterior edge of the masticatory muscle.

Muscles of expression of the buccal region are presented by the lower part of m. Afferent nerves are the branches of n. Efferent nerves are the branches of n. Layers and their characteristics. The skin of the buccal region is quite thin and contains a large amount of sweat and sebaceous glands. It is firmly attached with the well-devel- oped layer of the cellular tissue. Facial artery and vein pro- ceed inside the cellular tissue.

Buccal fat pads are practically important formations which are located in the subcutaneous layer. They are located at the back of the posterior limit and attach to the frontal edge of the masticatory muscle. Buccal fat pads are enclosed into a quite tight fascial capsule, which separates it from the cellular tissue and buccal muscle located deeper. One part of the pad is located in an adjacent, parotid-mas- ticatory area, between the deep surface of the m.

There are several processes coming from this part of the pad: temporal, orbital and pterygo- palatine, that proceed into the corresponding regions. The temporal process follows the zygomatic bone along the outer wall of the orbit through masticatory-maxilar space and reaches the front edge of the temporal muscle. Here this process attaches with subfascial temporal space and the deeper temporal space between the bone itself and deep surface of temporal muscle.

Orbital pad process is located in the infratemporal fossa adjacent to the lower orbital fis- sure. Pterygoid-palatal pad process proceeds further into the outer basis of the cranium between the posterior edges of the upper and lower jaw and the base of the pterygoid process.

Sometimes this process reaches the lower medial part of the superior orbital fissure and enters into the the skull cavity through it, where it attaches to the wall of intra- cavernous dural sinus. Blood vessels. The blood supply is performed by a. One of the most important facial vein anastomoses with pterygoid plexus can be found on this line approximately on the level of ala nasi.

There are two venous nets on the face: superficial consists of facial and submandibular veins and profound is presented by pterygoid venous plexus. Motor branches of the facial nerve that innervates the mimic muscles are projected along the lines diverging in a fan manner from a point lower and forward to the tragus.

The nerves go through bone foramena. Foramen infraorbitale is projected 0,5 cm below the middle of infraorbital margin. Foramen mentale is projected on the middle body of the mandibular between 1 and 2 premolars. Foramen mandibular is projected in the mid- dle poit between the anterior and posterior edge of the man- dibular branch for 2, cm upwards from the lower edge. When you place your hand in this way rr.

Part 1: The Head 71 Profound face area Fig. Blood supply. Maxillary artery a. It supplies blood to the deeper parts of the face. Maxillary artery is divided into three segments: 1. The first segment mandibular part is located medially to the branches of the mandible. The fol- lowing arteries begin from the first segment: - Deeper ear artery a. Its terminal branch is the mental artery a. It goes through foramen with the same name foramen mentale and then appears in the chin area.

After that it enters the cranial cavity and divides into anterior and posterior branches ramus anterior et ramus posterior. The artery carries blood to dura mater. Side view 1 - ramus parietalis a. There it carries blood to the tri- geminal ganglion ganglion trigeminale. The second section pterygoid section is located in the temporopterygoid space spatium tempo- ropterygoideum. The third segment pterygopalatine part corre- sponds to the fossa pterygopalatina. It has the fol- lowing branches: - descending palatine artery a. It leaves through the infraorbital foramen foramen infra- orbitale and splits into multiple branches within the canine fossa fossa canina.

Blood outflow. Within infratemporal and pterygopalatine fossae there is pterygoid venous plexus plexus pterygoi- deus , which accepts the blood coming from the following vessels: - middle meningeal veins vv. Mandibular nerve n. On leaving cranial cavity through foramen ovale it devides into the following sensory branches: - Meningeal branch ramus meningeus passes through the spinous foramen foramen spino- sum to the dura mater.

The branches of the mandibular nerve give sensory fibers coming to the parasympathetic ganglions: ear ganglion gan- glion oticum , submandibular ganglion ganglion subman- dibulare and sublingual ganglion ganglion sublinguale. Cellular spaces of profound face areas Fig. They include temporomandibulopterygoid and interpterygoid cel- lular spaces and retromandibular, pterygoid fossae.

Temporomandibulopterygoid space spatium temporoman- dibutopterygoideum is located between the lower jaw, the temporal muscle and the ptrerygoid muscle located deeper. Interpterygoid space spatium interpterygoideum is locked between the two pterygoid muscles. Maxillary artery and its branches, the venous pterygoid plexus, plexus venosus ptery- goideus, are also located here. By the course of the lingual nerve this space communicates with the adipose tissue of the mouth.

That is why the phlegmons developed here can spread to adipose tissue of the oral cavity bottom. Pus can also get into pterygoid fossa if it flows forward. Retromandibular fossa is a depression located behind the ascending branch of the mandible. The bottom of this depression is formed by styloid process with m. Within retromandibular fossa there are glandula parotis, a. Infratemporal fossa or fossa infratemporalis is located deeper than parotid-masticatory area.

It has the following limits: from the outside it is limited by the ascending branch of the mandible, ramus mandibulae, from the inside - with the out- side plate of the pterygoid process, lamina externa processus pterygoidei; anterior limit is the tuber of the upper jaw, tuber maxillae; posterior limit is the styloid process with anatomical muscle heap; upper limit is the infratemporal surface, facies infratemporalis, and the infratemporal crest, crista infratem- poralis; bottom limit is the the oral cavity.

The fossa is filled with the lateral pterygoid muscle, m. Inside the fossa you can find: maxillary artery, a. Behind the articular process there are 5 branches: A. The following arteries are located at the level of incisura man- dibulae and processus coronoideus: a. Part 1: The Head 81 Veins of infratemporal fossa form pterygoid plexus, plexus pterygoideus. This plexus widely anastomoses with v. Infratemporal fossa communicates with pterygoid fossa - fossa pterygopalatina, which is limited with tuber of the upper jaw, tuber maxillae, from the front, and with the pterygoid process, processus pterygoideus from behind, with the vertical palatal plate - medially, and with the larger wing of the sphenoid bone from the top.

Pterygoid fossa communicates with the orbit through the lower orbital fissure, fissura orbitalis inferior, and does so with the nasal cavity through the foramen sphenopalati- num, which is located on the medial wall of the pterygoid fossa. It also links with the mouth through canalis palatinus major, opens into smaller and larger palatine foramens, foramen palati- num major et minor. It also communicates with the the middle cranial fossa through a round foramen - foramen rotundum, and with the outer cranium base surface - through the ptery- goid canal, canalis pterygoideus.

Inside pterygoid fossa there is the terminal section of the jaw artery, from which within this fossa the following branches start: a. Parotid-masticatory region regio parotideomasseterica has the following limits: top limit is the zygomatic arch arcus zygomaticus , bottom limit is the bottom margin of the lower jaw margo inferior mandibulae , anterior limit is the ante- rior margin of the masseter muscle m. Derma - or the skin. Panniculus adiposus - subcutaneous adipose tissue. Fascia superficialis - superficial fascia.

Lobed structure plays a major role in migrating nature of gland inflammation. During purulent parotitis abscess is usually being drainaged through the external auditory canal because of the absence of the fascia on the upper margin of the gland and because gland lies closely to the external auditory canal, which is why pus can easily break out through the incisura cartilaginis meatus acustici. After breaking out pus infiltrates parapharyngeal space, and from there across the pharynx and esophagus it continues to flow into posterior mediastinum which causes mediastenitis.

Glandula parotis is parotid gland. In its depth you can find: - A. Its branches create plexus parotideus in the depth of the gland; - Ductus parotideus Stenoni is an excretory duct of the parotid gland, located in the horizontal way. When it reaches the front margin of the m. At the level of the sixth or seventh superior tooth there is a place where parotid duct opens into the vestibulum of the oral cavity. But in chewing and dilation of the buccal muscle the duct opens and the saliva flows freely into the oral cavity; - Nodi lymphatici parotidei superficiales et profundi - superficial and profound parotid lymph nodes 5.

It is located at the anterior region of the parotid-masticatory area. Os mandibula or the lower jaw is located in the posterior part of parotid-masticatory area. That is the point where a. Temporomandibular joint articulatio temporo- mandibularis is located in the posterior superior part of the parotid-masticatory region. Infraorbital region Fig. The Layers of Suborbital Region: 1. The skin cutis 2. Fat deposits panniculus adiposus 3. Superficial mimic muscles layer.


Under the superficial layer of muscles there are angular artery and vein a. Angular vein is directed downward and laterally, crossing the infraorbital area diagonally at the same time. Profound layer of the mimic muscles includes muscle that lifts the corner of the mouth m. The anterior surface of the upper jaw facies ante- rior maxillae with the canine fossa fossa canina and suborbital foramen foramen infraorbitale. Infraorbital vessels and nerve a. Suborbital vessels bring the blood to the soft tissues around canine fossa. The branches of the infraorbital nerve innervate the skin from the lower eyelid to the upper lip.

Chin area regio mentalis is separated from the lower lip with mento-labial fold sulcus mento-labialis. From the bottom it is limited by the margin of the lower jaw, and from the outside by the vertical lines drawn down from the corners of the mouth. The skin cutis is tightly joined with the muscu- lofascial layer lying deeper.

The skin itself is inner- vated by the mental nerve n. Musculofascial layer stratum musculofasciale. This layer has the following formations: - Mimic muscles: muscle depressing mouth angle m. The periosteum. The body of the mandible corpus mandibulae has the mental foramen foramen mentale at the level of the second molar, which is the entry point of blood vessels and nerves with the same name. Buccinator ; it accepts lymph coming from the frontal face surface. Part 1: The Head 91 - Anterior submandibular lymph nodes nodi lym- phatici submandibulares anteriores are located after the submandibular salivary gland; they carry lymph coming from the buccal nodes and the fron- tal face surface.

They are not always present. There is usually one or two of them. So, the lymph flows from the head to the neck, where it passes through the superficial and profound cervical lymph nodes nodi lymphatici cervicales superficiales et nodi lym- phatici cervicales profundi. During this process, the super- ficial cervical lymph nodes receive lymph from the neck, mastoid, and superficial parotid lymph nodes; and the profound nodes receive lymph coming from the profound parotid, submandibular, submental and retropharyngeal lymph nodes. Congenital Face Disorders Macrostomy is a horizontal fissure.

It is a congenital defect of the soft tissues of the mouth angle and cheeks, which results into extension of the mouth fissure. It can reach the ear accompanied by muscle hypoplasia, inability to close the mouth and drooling. Coloboma is an oblique lateral face fissure, which stretches from the inner eye angle to the lower lip. Colobomas are often accompanied with conjunctivitis. Fissure of the upper lip is one of the most common congeni- tal disorders of the face. It is most commonly seen in boys and can be accompanied with a fissure in the palatinum.

In case of incomplete fusion of upper lip defect affects only soft lip tis- sues. In case of complete infusion defects can be observed not only in the soft tissues, but also in the upper jaw. Deformation of nasal septum and flattening of the ala of the nose can also be seen on the affected side. In case of complete double-sided infusion intermaxillary process is shifted forward and held with the vomer, covered with small, isolated skin piece and the vermillion lip border. In this case breastfeeding is com- pletely impossible.

Hard palatinum fissure appears as a result of the delay in the development of palatal processes of the upper jaw, which is why the latter does not reach the vomer and does not join with it. In the case of incomplete fusion it is possible to observe splitting of the tongue, splitting of both tongue and soft palate; splitting of the tongue, soft and hard palate. In case of com- plete infusion in addition to phenomena described above it is possible to observe the infusion of maxillar alveolar process.

Complete palatinum infusion is usually combined with infu- sion of the upper lip. During one-sided palatinum infusion fissure connects the oral cavity with the one half of the nasal cavity. During two-sided palatinum infusion fissure connects the mouth with the both halves of the nasal cavity, so that vomer becomes visible in the middle of the fissure. Usually this disorder is accompanied by hyperplasia of maxilla and shortening of soft palatinum. Abscess is a purelent inflammation of tissues with their melt- ing and formation of the purelent cavity.

It can develop in subcutaneous tissue, muscles, bones, organs and between them. The cavity of abscess can have both a simple round form and complex form with many pockets. At first walls of abscess are covered by purelent-fibrous impositions and pieces of necrotic tissues. Then the inflammation zone devel- ops around the abscess periphery, that leads to the formation of a pyogenic membrane formed by the connective tissue. Abscess of infratemporal fossa is a pure- lent-inflammatory process limited by the bounds of cellular space of this fossa.

As the oval and spinous foramena open in the upper wall of the fossa there is the possibility of the infectious-inflam- matory process spreading into the brain coat. Infratemporal fossa contains the lower segment of temporal muscle and pterygoid muscles; maxillary, middle meningeal, lower alveolar, profound temporalis, buccal arteries and pterygoid venous plexus; mandibular, lower alveolar, lingual, buccal nerves, chorda tympani and ear ganglion.

Due to the abscess occurrence there is a high pressure in this region, which leads to the ompression of the muscles, arteries and nerves in the infratemporal fossa. Profound temporal and buccal arteries shift to the lateral plate of the pterygoid process of the sphe- noid bone. The buccal nerve shifts towards the zygomatic arch, lower mandibular and lower alveolar nerves - closer to the lower jaw. In case of the difficult eruption of the lower wisdom teeth complicated by pericoronitis and retromolar periostitis, purelent exudate can accumulate in the space behind the wisdom teeth named retromolar cav- ity.

Pus can accumulate both between the periosteum and bone, and can spread over loose fiber of the front surface of the lower jaw in the direction of palatine tonsils causing their inflammation. Abscesses of sublingual roller and jaw tongue groove. Sublingual roller, plica sublingualis, is formed by sublingual salivary gland enveloping loose fiber and coated with a thin mucusa.

Abscess causes compression of salivary gland located in sub- lingual space of lingual nerve, artery and vein. Due to the abscess development lingual artery becomes separated from all these elements and pressed to the sublingual-lingual muscle. The infection can spread into the cellular spaces of sublingual and submandibular regions, pterygo-mandibular cellular space.

Phlegmon is an acute diffuse purelent inflammation of cellular spaces, unlike abscess phlegmon has no precise boundaries. Phlegmon of the temporal region can be a result of dissemination of inflammatory infiltrates from pterigo-mandibular or peripharyngeal spaces, infratempo- ral, retromandibular and pterigopalatine fossae and from the buccal region. Phlegmon can be located between the skin and temporal aponeurosis, surface and deep sheets of tempo- ral fascia, and under the deep sheet of temporal fascia. When phlegmon is located between the skin and temporal aponeurosis the compression takes place in the medial direc- tion of a.

In interaponeurotic or subaponeurotic phlegmon the com- pression takes a place in a. It makes conditions for the pus to spread under the chewing muscle and towards perypharingeal space. Phlegmon of perypharyngeal space often occurs as a result of the infection from the side of the palatine tonsils when they are inflamed, as well as purelent-inflammatory processes in the phlegmons located in the submandibular, sublingual and pterygo-mandibular spaces. As the perypharingeal space is connected with anterior mediastenum by neurovascular bundle the infection can spread to the mediastenum.

The infection can spread along lingual artery to the bottom of the mouth. Phlegmon of mouth bottom is a common purelent-inflam- matory process exciting two or more cellular spaces located higher or lower than the diaphragm of the bottom of the mouth. The bottom of the mouth or its bottom wall is formed by soft tissues unit located between the tongue and hyoid bone in which inflammatory processes often develop. Here the lingual and upper tyroid arteries and veins, sublingual nerve and branches of facial nerve are located and they are squeezed when phlegmons form.

Parotitis Fig. Lobular structure of the gland predisposes to the migratory nature of inflammation. In purulent parotitis the abscess often occurs through the external auditory canal, that is due to the lack of a fascia on the upper edge of the gland and the adherence of the gland to the external auditory canal where pus breaks out through incisura cartilaginis meatus acustici. If the internal plate of the fascial gland is broken the pus can penetrate into the parapharyngeal space and then along pharynx and esofa- gus to the posterior mediastenum with the development of mediastenitis.

Patotopography of parotitis: the mucous membrane of the oral cavity around the parotid duct is full, swollen, edema extends to the cellulose of the parotid and neck. Increased parotid glands can press the neurovascular bundle that consists of external carotid artery and vein, n. The facial nerve passes through the thickness of the gland and its compression leads to the paralysis of mimical muscles. Pannus Fig. Pannus is formed due to the work of synovial cells that form a granulation tissue. Part 1: The Head cause the stimulation of synovial cell proliferation.

This factor contributes to the growth of blood vessels in the cartilages. A magnetic resonance tomogram shows the formation of pannus - infiltration with neoplasm of connective tissue and development of vessels in this region. Because of the pannus, the spi- nal cord is compressed by the tooth process of the sinus through the dental fossa. In the average size of the maxillary sinus, its bottom is approximately at the level of the nasal cavity bottom, but often it is lower.

Labial retromandibularis palatal Ramia A. Maxillaris sup. Arteria Ramia carotica AA. Linguales orbitalis Plexus venosus externa pterygopalatinum A. Rami Maxillaris Nervus N. Oculo- Nerves buccales N. Olfactorius N. Maxillaris ototemporalis motorius of facial nerve N. Glosso- Facial nerve N.

Trochlearis pharyngeus N. Buccalis Ramin. Adducens etmaxillaris N. Vagus Rami zygomatici N. Hypoglossus N. Mandibularis N. Part 2: The Neck Topographic Anatomy of the Neck Topographic of neck Attachment 3 The boundary between the head and neck is the hyoid bone, os hyoideum. Above it - suprahyoid region, regio suprahyoi- dea, which belongs to the head and below - subhyoid region, regio infrahyoidea, which refers to the neck. The boundary line runs from the border to the corners of the bones of the lower jaw, goes around the external auditory canal and mas- toid and goes back up to the upper nuchal line and protube- rantia occipitalis externa is found with a similar line on the opposite side.

The lower limit of the neck is on the handle of the sternum manubrium sterni, clavicle, scapula acromion process and then coming to the spinous process of VII cervical vertebra. External reference points and divide by the area Fig. The neck is divided into a front region, regio cotti anterior, and posterior region, regio cervicis. Within the anterior neck surgery is performed most frequently, as this is where most of the major organs in the neck are located.

Torticollis, sometimes developing in early childhood, degeneration occurs when the fascial cap- sule and contraction of m. Skeletopy and the projection of organs and neurovas- cular bundles on the surface of the skin. Larynx lar- ynx is located at the level of the lower edge of C4 to C6. Windpipe trachea is located on the lower edge of the C6 to the upper edge Th5, where the bifurcation of the tra- chea.

Throat pharynx is located on the base of the skull to the bottom of C6. Esophagus oesophagus extends from the lower edge of C6, passes through the thoracic cavity and terminates in the abdominal cavity at the level of Th Thyroid glandula thyreoidea - lateral lobes are located at the level of the larynx, and the isthmus of the gland lies in front of the trachea at the level from the first to the third of its cartilage. Parathyroid glands glandulae parathyroidea four in num- ber, are arranged between the capsule and the fascial sheath thyroid on the rear surface of its side lobes.

Upper glands lie at the lower edge of the cricoid cartilage, the lower one trans- verse finger above the lower pole of the lateral lobes of the thyroid gland. In violation of the innervation of the muscles of the neck becomes flabby appearance. Slightly closed fascial vagina m. Lower down the space communicates with the anterior mediastinum, which can move the inflammatory processes arising in the neck.

The sheets of the fascia is truncus sympathycus three cervical nodes. In front of the fascia is the fifth cellular spaces, which extends to the level of pharyngeal lymphatic ring Pirogov-Valdeyra and down behind the esophagus and trachea, accord- ing to the posterior mediastinum. Posterior to the neck of - between the fourth and vertebral fifth fascia of the neck - is behind the visceral cellular spaces, spatium retroviscerale. On either side of the neck organs are enclosed in a common fascial sheath common carotid artery, internal jugular Vienna, the vagus nerve and the deep lymph nodes of the neck.

This so-called cellular spaces of the neuro- vascular bundle. Behind the third fascia is pretracheal space communicating with the fiber behind the breastbone. Infection visceral fat before bed can lead to front mediasteni- tis. It is in this tissue can be injected air at the technical errors that arise when a tracheostomy is performed. Reflex Zones 1. The main neurovascular bundle of the neck com- mon carotid artery, the vagus nerve and the inter- nal jugular Vienna - projection above; 2. Sinocoratid reflexogenic zone bifurcation of the common carotid artery - is projected on the upper edge of the thyroid cartilage 1 cm outwards; 3.

Application of the sympathetic trunk: the top node is projected onto the transverse process of C3; Average unit is projected onto the transverse pro- cess of C6; cervicothoracic stellate node is pro- jected at the level of the neck of the first rib; 4. The subclavian artery and brachial plexus trunks projected in the middle of the clavicle. Lymphatic vessels and regional lymph nodes Fig. In the neck there are two groups of lymph nodes: front neck, nodi lymphatici cervicales anteriores, and lateral neck, nodi lymphatici servicales laterales.

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  • Lateral units also constitute superficial and deep group. Surface sites lie along the external jugular vein. Deep nodes form a chain along the internal jugular vein, the lateral artery of the neck supraclavicular nodes and the back of the pharynx - retro- pharyngeal nodes. Because of the deep cervical lymph nodes deserve special attention nodus lymphaticus jugulo-digastricus and nodus lymphaticus jugulo-omohyoideus. The first is located on the internal jugular vein at the level of a large horn of the hyoid bone. The second lies in the internal jugular vein just above the m.

    They take language lymphatic vessels, either directly or through the submental and submandibular lymph nodes. They can get the cancer cells when the tumor affects language. The retropharyngeal nodes, nodi lymphatici retropharyn- geal, lymph flows from the mucous membrane of the nasal cavity and paranasal its pneumatic cavities of the hard and soft palate, base of the tongue, nose and oropharynx, as well as middle ear. From all of these lymph nodes is flowing to the cervical nodes.

    Triangles of the Neck The inner medial triangle of the neck trigonum cervi- cis mediale Fig. The medial triangle isolated suprahy- oid region regio suprahyoidea and subhyoid region regio infrahyoidea. Suprahyoid region Fig. Layered suprahyoid topography of the area: The skin cutis ; Body fat panniculus adiposus ; The outer plate of the superficial fascia lamina externa fasciae superficialis ; Platysma platysma ; The inner plate of the superficial fascia lamina interna fasciae superficialis ; En neck fascia fascia colli propria ; Submandibular gland glandula submandibu- laris ; Digastric anterior belly venter anterior m.

    Digastrici ; Mylohyoid muscle m. Within the area there are three suprahyoid triangle: subman- dibular triangle, lingual triangle, and submental triangle. Borders subhyoid region: top - hyoid and posterior belly of digastric venter posterior m. Digastiici , laterally and below - the front edge of the sterno- cleidomastoid muscle. Median line subhyoid area is divided into symmetrical halves. Layered topography of the sublanguage area. Platysma, inner plate of superficial fascia, lamina interna fasciae superficialis, intrinsic fascia of neck, fascia cervicalis propria, suprahorn interperoneurotic space, spatium interaponeuroticum suprasternale, scapular-fascia fascia, fascia omoclavicularis, superficial muscle layer, stra- tum musculare superficiale, parietal lamina of intrasternal fascia, lamina Parietalis fasciae endocervicalis, vestibular space, spatium previscerale, visceral plate of intracereal fascia, lamina visceralis fasciae endocervicalis, posterior vascular space, spatium retroviscerale, invertebrate fascia, fascia prevertebralis, deep Th muscular layer, stratum mus- cularis profundum, cervical spine, pars cervicalis columnae vertebralis.

    The sublingual region is divided into the drowsy and scap- ular-tracheal triangles, trigonum caroticum and trigonum omotracheale. The outer lateral triangle Fig.

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    Sternocleidomastoideus , below - the collarbone clavicula , laterally - the trapezius muscle m. The lateral tri- angle of the neck lower abdomen omohyoid muscle venter inferior m. Omohyoidei divided by scapuloclavicular and scapular-trapewievidny triangles trigonum omoclaviculare et trigonum omotrapezoideum. NVB inner and outer triangles of the neck Fig.

    It is supplying the brain, the organ of sight and most of the head. Common carotid artery rises almost vertically upwards and out through the apertura thoracis superior in the neck. Here it is on the anterior surface of the transverse processes of the cervical vertebrae and surrounding muscles on the side of the trachea and esophagus, behind the sternocleidomastoid muscle and fascia of the neck pretracheal plate with embed- ded in the omohyoid muscle. Outside of the common carotid artery is the internal jugular Vienna, and back in the groove between the two - the vagus nerve.

    Common carotid artery in its course branches does not at the level of the upper edge of the thyroid cartilage is divided into: - External carotid artery arteria carotis externa , - The internal carotid artery arteria carotis interna. External carotid artery Fig. Then it falls in submandibular hole and enters into the body of the salivary gland. At the level of the neck of the artic- ular process of the mandible external carotid artery is divided into the maxillary artery and superficial temporal artery.

    External carotid artery is divided into 4 groups of branches of topographic features. The group of front branches - Upper thyroid artery - Lingual artery 2. The group of medial branches - Ascending pharyngeal artery 4. The group of terminal branches - Maxillary artery - Superficial temporal artery The internal carotid artery Fig. In it is distin- guished neck, rocky, cavernous and cerebral part.

    Going up, it initially lies some lateral and rear of the external carotid artery. Laterally of it is internal jugular Vienna, v. On its way to the base of the skull internal carotid artery runs along the side of the pharynx cervical part, pars cervicalis medial to the parotid gland, separated from the stylohypoglossal and stylopharyngeus muscle. In the cervical internal carotid artery branches usually do not give. Here it is somewhat expanded by the carotid sinus, sinus caroticus.

    From the part of the brain a. On its way ophthalmic artery gives: 1. Century medial artery, aa. Anterior cerebral artery, as well. The topography of the subclavian artery Fig. Leaves often right of the brachiocephalic trunk truncus bra- chiocephalicus , and the left - from the aortic arch arcus aortae. Conventionally, it is divided into three segments. The first segment - from the beginning of the arteries to the interscalene space.

    The second segment of the artery is located within the interscalene space is on I rib on it from the artery remains imprint - subclavian artery sulcus sul- cus a. The third segment begins at the outlet of the interscalene space to the outer edge of the ribs I, which already begins axillary artery a. The artery is arc- shaped. In the first otrez-ke it goes in superolateral direc- tion lies horizontally in the second, and the third should be inclined downward.

    Subclavian artery gives five branches: three in the first seg- ment, and one in the second and third segments. The branches of the first segment: vertebral artery a. Vertebralis , Internal thoracic artery a. External jugular Vienna Fig. Jugularis externa is formed at the angle of the lower jaw at the confluence of the posterior auricular vein v. Auricularis posterior and anasto- mosis with retromandibularis vein v. The internal jugular Vienna v.

    Jugularis interna Brachiocephalic veins: right and left, rr. Thoracic duct, ductus thoracicus, collects lymph from both lower limbs, organs and pelvic wall and abdominal cavities of the left lung, the left half of the heart wall of the left half of the chest, on the left arm and the left side of the neck and head. The left and right lumbar trunks collect lymph from the lower extremities, and the walls of the pelvis, abdomen, lumbar and sacral regions of the spinal canal and spinal membranes.

    Phrenic nerve cervical plexus n. Phrenicus is formed from the anterior branches of the cervical spinal nerves. Initially, both the nerves are in the upper mediastinum, then move to the middle mediastinum and are located on the side of the pericardium, in front of the root of the corresponding lung. There phrenic nerve lies between the pericardium and medi- astinal pleura and ends in the thickness of the diaphragm. Sensitive-diaphragmatic peritoneal branches rr. Phrenicoabdominales , are in the abdominal cavity and inner- vate the peritoneum covering the diaphragm. The branches of the right phrenic nerve pass without stopping in transit , through the celiac plexus to the liver.

    The vagus nerve in humans, the tenth pair of cranial nerves, doubles mixed nerve containing the motor, sensory and autonomic sympathetic and parasympathetic fibers. It has three core in the medulla oblongata, in common with the glossopharyngeal nerve: dorsal vegetative , ventral, or double motor , and the core t. The lower laryngeal nerve n. Laryngeus inferior - the final branch of the recurrent nerve, passes through the esophageal- tracheal groove medial to the thyroid lobe and at the level of the cricoid cartilage is divided into two branches - the front and rear.

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